hypopituitarism Flashcards
what happens to the pituitary gland as we get older
it decreases
pregnancy causes a change in pregnancy
yep, it gets bigger due to the proliferation of lactrotophes
compression of optic chiasm leads to what type of eye issue?
bitemporal hemianopsis (not seeing anything from the sides
Rare to see compression of internal carotid.
yep
Embryolgicaly, anterior pituitary derives from _______________ as Rathke’s pouch. Posterior pituitary from __________ as outpouching from floor of third ventricle.
Embryolgicaly, anterior pituitary derives from oral ectoderm as Rathke’s pouch. Posterior pituitary from neural primordial as outpouching from floor of third ventricle.
From the pituitary, venous blood drains into
inferior petrosal sinus.
posterior pituitary “bright spot”
indication that there is a disease process happening
deficiency most common cause for hypopituitarism associated with GH, Prol, TSH deficiency and variable gonadotroph. Can be associated with nl, hypoplastic or hyperplastic pituitary.
PROP 1 (profit of pit-1)
Growth retardation Decrease in energy Constipation Cold intolerance Dry skin Weight gain
TSH DEFICIENCY
Weakness Weight Loss Fatigue Dizziness (standing) Pallor Hypoglycemia Nausea/Vomiting Circulatory Collapse
ACTH DEFICIENCY
craniopharyngioma is a
non-functional tumors
Infarction of the pituitary in pregnancy
sheehan’s syndrome
Pituitary insufficiency (hypopituitarism) may arise from (2)
congenital defects or acquired disease of the pituitary or hypothalamus.
Pituitary hormone levels may be inappropriately normal relative to target hormone levels in hypopituitarism.
yep
For example, a normal TSH may be seen with a low free T4 in a patient with untreated central hypothyroidism.
To test ACTH reserve directly, an insulin tolerance test can be done (also tests GH reserve). Metyrapone can also test ACTH reserve… why?
which inhibits the last step in cortisol synthesis
A dehydration test can be done to assess for central diabetes insipidus where ADH will be _____ with a high serum osmolality and low urine osmolality.
low
The presence of diabetes insipidus, slightly elevated prolactin and one or more anterior pituitary deficiencies suggests involvement of the ______________
pituitary stalk or hypothalamus.
__________________ must be replaced first if multiple hormones are deficient. Thyroid hormone would be next. Gonadal hormone replacement and growth hormone replacement would depend on the individual patient.
Glucocorticoids
Normal adenohypophysis contains a heterogeneous, nested population of ___________ secretory cells that on H&E stain are (1) (cytoplasmic granules stain with eosin, which is an acidic dye; make GH and Prolactin), (2) (cytoplasmic granules stain with hematoxylin, which is a basic dye; make ACTH, FSH/LH), or (3) (make any of the hormones but are sparsely granulated)
neuroendocrine-type
- acidophilic
- basophilic
- chromophobic
Neurohypophysis consists of axons and glia, no ___________________
secretory cell bodies
The adenohypophysis has a large functional reserve.
yep
Pituitary apoplexy is an
infarcted pituitary adenoma.
Common cancers, e.g. breast and lung, frequently metastasize to the pituitary and can selectively affect the ________________ causing diabetes insipidus.
neurohypophysis,
Empty sella syndrome is an
intrasellar arachnocoele
Differential dx of intrasellar cysts includes (1) (squamous, cuboidal, columnar, sometimes respiratory lining, sometimes with goblet cells), (2) (looks like complete skin with dermal appendages) (3) (looks like epidermis without dermal appendages).
- Rathke cleft cyst
- dermoid cyst
- epidermoid cyst
Small asymptomatic infarcts occur in various conditions
sickle cell disease and hypovolemic shock
Large infarcts causing functional impairment are most common in __________
obstetric shock (Sheehan’s syndrome).
